Maria Kugelberg

One million cataract surgeries: Swedish National Cataract Register 1992-2009.

This review summarizes data collected by the Swedish National Cataract Register, which now contains data pertaining to more than a million cataract surgery procedures, representing 95.6% of the surgeries performed in Sweden during 1992-2009. During this period, the rate of cataract surgery rose from 4.47 to 9.00 per 1000 inhabitants. The mean patient age increased until 1999 but has slowly decreased since then. Preoperative visual acuity has risen steadily. The distribution between the sexes was stable until 2000, after which the proportion of women slowly decreased. Registration of subjective benefit has brought new knowledge regarding indications and expectations. An improved questionnaire, Catquest-9SF has been used since 2008. The outcome register generally shows good results from the surgery. Endophthalmitis has decreased from 0.10% to below 0.040%.

Cataracts in children.

&NA; Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow‐up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after‐cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight‐threatening complication and is common if surgery is performed early. Life‐long follow‐up is essential in these cases.

Aiming for emmetropia after cataract surgery: Swedish National Cataract Register study

PURPOSE: To assess and analyze refractive outcome after cataract surgery in Sweden from 2008 though 2010. SETTING: Swedish cataract surgery units participating in outcome registration of National Cataract Register. DESIGN: Cohort study. METHODS: Planned and actual postoperative refractions were analyzed for cataract procedures and preoperative and postoperative corneal astigmatism for procedures performed in 2008 though 2010. Induced astigmatism was calculated with Naeser and Behrens polar coordinates. RESULTS: Postoperative refraction was analyzed for 17 056 procedures and corneal astigmatism for 7448 procedures. Emmetropia was targeted in 78.1% of eyes and achieved in 52.7%; 43.0% had less than 1.00 diopter (D) of astigmatism. “Reading myopia” of −3.5 to −1.6 D was targeted in 7.0% of eyes and achieved in 7.8%. Planned hyperopia greater than 1.0 D or myopia greater than −3.5 D was rare. The mean absolute biometry prediction error was 0.402 D ± 0.338 (SD) in all eyes; however, astigmatic eyes and eyes planned for myopia or hyperopia had higher biometry prediction errors. Younger patients were more often astigmatic and planned for a more myopic outcome. Preoperatively, one third of eyes had more than 1.0 D of corneal astigmatism; postoperatively this figure was largely unaltered. The mean induced astigmatism was 0.525 ± 0.804 D in all eyes. CONCLUSIONS: Emmetropia (spherical equivalent −0.5 to +0.5 D and <1.0 D astigmatism) is the goal in most cataract cases but was reached in only 55% of eyes planned for emmetropia. Factors precluding emmetropia included remaining corneal astigmatism and biometry prediction errors in astigmatic and ametropic eyes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Posterior capsule opacification: Comparison of 3 intraocular lenses of different materials and design

Purpose: To compare posterior capsule opacification (PCO) after cataract surgery with implantation of 3 intraocular lenses (IOLs) of different materials and design. Setting: St. Eriks Eye Hospital, Stockholm, Sweden. Methods: In this prospective clinical study, 180 patients had standardized phacoemulsification performed by a single surgeon and were randomized to have implantation of a heparin‐surface‐modified (HSM) poly(methyl methacrylate) (PMMA) IOL (809C, Pharmacia & Upjohn), a silicone IOL (SI‐40NB, Allergan), or an acrylic IOL (AcrySof® MA60BM, Alcon). To morphologically evaluate PCO, retroillumination photographs were obtained and analyzed using Evaluation of Posterior Capsule Opacification computer software. The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded. Results: After 2 years, the HSM PMMA IOL group had significantly more PCO than the silicone and AcrySof IOL groups; the silicone group had significantly more PCO than the AcrySof group (P<.05). The Nd:YAG capsulotomy rate was 20% in the HSM PMMA group, 22% in the silicone group, and 8% in the AcrySof group. Conclusion: Patients with an AcrySof IOL developed significantly less PCO than those with a silicone or HSM PMMA IOL with a round‐edged design.

Decreasing rate of capsule complications in cataract surgery: eight-year study of incidence, risk factors, and data validity by the Swedish National Cataract Register.

PURPOSE: To define the incidence of capsule complication and its risk factors in Sweden over an 8‐year period. SETTING: Fifty‐two ophthalmic surgery units in Sweden. DESIGN: Database study. METHODS: Data were collected prospectively in the Swedish National Cataract Register (NCR) from 2002 through 2009. The NCR contains 97.3% of the total number of cataract extractions in Sweden over the 8‐year study period. One mandatory variable in the register is capsule complications during surgery. As a means to validate the accuracy of register data on capsule complications, a randomly selected sample of 2400 registrations was compared with corresponding medical records. RESULTS: The analyses were based on 602 553 cataract extractions reported to the NCR. A capsule complication was reported in 12 574 cataract extractions, corresponding to a frequency of 2.09%. The incidence of this complication consistently decreased each year from 2002 to 2006, after which it stabilized. Poor corrected distance visual acuity in the surgical eye (≤ 0.1), the occurrence of glaucoma, diabetic retinopathy, and age were among the parameters significantly related to a capsule complication. Some of these parameters also decreased over time. However, even after adjusting for this, there was an obvious decrease in capsule complications over time. The validity test showed a certain underreporting of capsule complications to the registry, but it was not significant and did not change over time. CONCLUSION: The incidence of capsule complications decreased over time. This may be partly the result of fewer risk factors and of better surgical quality. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Two-year follow-up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens

Purpose:  To evaluate posterior capsule opacification (PCO) 2 years after cataract surgery following implantation of a hydrophilic or a hydrophobic single‐piece acrylic intraocular lens (IOL) with a sharp edge.

Factors related to the degree of success in achieving target refraction in cataract surgery Swedish National Cataract Register study

PURPOSE: To analyze which factors influence the mean absolute prediction error after cataract surgery. SETTING: Forty‐nine eye departments participating in the Swedish National Cataract Register (NCR). METHODS: In this prospective multicenter comparative nonrandomized study, ophthalmology departments in Sweden voluntarily reported to the NCR the outcomes of every cataract extraction performed during the month of March from 2000 through 2005. During this period, 49 of 55 ophthalmology departments in Sweden reported data. Perioperative data describing visual acuity, sex, age, other eye diseases, target postoperative refraction, and achieved postoperative refraction were included in the study. Factors that could be related to the mean absolute prediction error were evaluated. Of the cataract extractions, 23 244 were eligible for analyses. Statistical analyses were performed using multiple regression and logistic regression. RESULTS: During the study years, the mean absolute prediction error decreased significantly (P<.0001). The mean absolute prediction error was larger in women than in men (P<.001) and in patients with low preoperative visual acuity (P<.0001). Glaucoma in the surgical eye was also significantly related to a large deviation from the target refraction. The precision in reaching the target refraction was not better in second‐eye surgery than in first‐eye surgery. Some clinics had a significantly smaller mean absolute prediction error than other clinics (P<.0001). CONCLUSIONS: Some preoperative factors were related to less success in reaching the planned postoperative refraction. Taking this into consideration, extra care is warranted in cases with these preoperative risk factors.

A Population-Based Study of the Risk of Diabetic Retinopathy in Patients With Type 1 Diabetes and Celiac Disease

OBJECTIVE Celiac disease (CD) is associated with type 1 diabetes (T1D). In the current study, we examined whether CD affects the risk of diabetic retinopathy (DRP) in patients with T1D. RESEARCH DESIGN AND METHODS This was a population-based cohort study. Through the Swedish National Patient Register, we identified 41,566 patients diagnosed with diabetes in 1964–2009 and who were ≤30 years of age at diagnosis. CD was defined as having villous atrophy (Marsh stage 3) according to small intestinal biopsies performed between 1969 and 2008, with biopsy reports obtained from Sweden’s 28 pathology departments. During follow-up, 947 T1D patients had a diagnosis of CD. We used Cox regression analysis with CD as a time-dependent covariate to estimate adjusted hazard ratios (aHRs) for DRP in patients with T1D and CD and compared them with patients with T1D but no CD. RESULTS Duration of CD correlated with the risk of DRP. When results were stratified by time since CD diagnosis, individuals with T1D and CD were at a lower risk of DRP in the first 5 years after CD diagnosis (aHR 0.57 [95% CI 0.36–0.91]), followed by a neutral risk in years 5 to <10 (1.03 [0.68–1.57]). With longer follow-up, coexisting CD was a risk factor for DRP (10 to <15 years of follow-up, aHR 2.83 [95% CI 1.95–4.11]; ≥15 years of follow-up, 3.01 [1.43–6.32]). CONCLUSIONS Having a diagnosis of CD for >10 years is a risk factor for the development of DRP in T1D. Long-standing CD in patients with T1D merits intense monitoring of DRP.

Visual outcomes and complications in surgery for ectopia lentis in children

PURPOSE: To evaluate postoperative visual acuity and complications in eyes with ectopia lentis having surgery with a sutured capsular tension ring (CTR) and intraocular lens (IOL). SETTING: St. Eriks Eye Hospital, Stockholm, Sweden. METHODS: Thirty‐seven eyes of 22 children had surgery for lens dislocation. Two types of capsular rings were used; a Cionni modified CTR and a conventional CTR. In all cases, the rings were sutured to the sclera with a 10‐0 polypropylene (Prolene) suture, the CTR and an AcrySof IOL (Alcon) were implanted in the capsular bag, and the posterior capsule was left intact. The preoperative and postoperative best corrected visual acuity (BCVA) and complications were studied retrospectively. RESULTS: The mean age of the patients was 52 months. Thirty‐three eyes had implantation of a Cionni modified CTR and 4 eyes, of a conventional CTR. The median preoperative BCVA (22 eyes) was 0.26 (range 0.015 to 0.65). The median postoperative BCVA (36 eyes) was 0.59 (range 0.2 to 1.0). The median follow‐up period was 27 months (range 1 to 59 months). Twenty‐six eyes had secondary surgery for visual axis opacification, with 5 eyes requiring 2 to 3 reoperations. Two eyes required secondary suturing for IOL decentration. Persistent amblyopia was observed in 3 eyes, with poor postoperative visual development. No eye had serious complications such as retinal detachment, endophthalmitis, or glaucoma. CONCLUSION: Surgery for ectopia lentis with a CTR and an AcrySof IOL implanted in the capsular bag and sutured to the sclera appears to be safe in children.

The outcome of cataract surgery measured with the Catquest-9SF.

Purpose:  The purpose of this study was to use the Catquest‐9SF to measure cataract surgery outcomes, and to use Rasch analysis to test the psychometric properties of this questionnaire, including its validity and responsiveness.